'Rapid review' methodology to inform a policy decision: when is it fit for purpose? A case study

Article type
Llewellyn A1, Simmonds M1, Brunton G2, Thomas J2, Sowden A1
1Centre for Reviews and Dissemination, University of York, United Kingdom
2EPPI-Centre, Social Science Research Unit, UCL Institute of Education, United Kingdom
Background: There appears to be an increasing use of 'rapid reviews' to inform policy decisions in a timely manner. However, there is relatively little consensus on rapid review methodology.
Objectives: To present as a case study our experience of conducting a 'rapid review' to inform a policy decision, and to discuss the strengths and limitations of our approach.
Methods: A systematic review of the impact of antiretroviral therapy (ART) on liver disease progression to inform policy decisions relating to patients co-infected with HIV and chronic hepatitis C was commissioned by the Department of Health in England. The short timeline (10 weeks) for completion of the review meant that a priori decisions were made to restrict: 1) the number of sources searched; 2) duplication in study selection; 3) patient and public consultation.
Results: We searched MEDLINE and EMBASE and identified 1748 potentially relevant studies. Thirteen observational studies were included in the review, of which six were combined in a meta-analysis. We found that lack of randomised controlled trial evidence is more likely to have a greater impact on the conclusions drawn than weaknesses in review methods. We will discuss specific issues encountered during the review, notably involvement of different stakeholders, ‘trust’ in rapid review findings, and willingness of decision makers to potentially compromise methodological rigour.

Conclusions: Our review provided a concise and transparent picture of the evidence available to inform future policy decisions related to patients co-infected with HIV and chronic hepatitis C. It was produced within a short time frame and omitted elements of the systematic review process such as comprehensive searching and double screening, and was therefore potentially at higher risk of bias and error than reviews adopting 'gold standard' methods. Implications of the review methodology used, the nature of the evidence synthesised and the policy context will be discussed.